Background
Patients with joint hypermobility syndrome/Ehlers–Danlos syndrome, hypermobility type (JHS/EDS‐HT) commonly suffer from pain. How this hereditary connective tissue disorder causes pain ...remains unclear although previous studies suggested it shares similar mechanisms with neuropathic pain and fibromyalgia.
Methods
In this prospective study seeking information on the mechanisms underlying pain in patients with JHS/EDS‐HT, we enrolled 27 consecutive patients with this connective tissue disorder. Patients underwent a detailed clinical examination, including the neuropathic pain questionnaire DN4 and the fibromyalgia rapid screening tool. As quantitative sensory testing methods, we included thermal‐pain perceptive thresholds and the wind‐up ratio and recorded a standard nerve conduction study to assess non‐nociceptive fibres and laser‐evoked potentials, assessing nociceptive fibres.
Results
Clinical examination and diagnostic tests disclosed no somatosensory nervous system damage. Conversely, most patients suffered from widespread pain, the fibromyalgia rapid screening tool elicited positive findings, and quantitative sensory testing showed lowered cold and heat pain thresholds and an increased wind‐up ratio.
Conclusions
While the lack of somatosensory nervous system damage is incompatible with neuropathic pain as the mechanism underlying pain in JHS/EDS‐HT, the lowered cold and heat pain thresholds and increased wind‐up ratio imply that pain in JHS/EDS‐HT might arise through central sensitization. Hence, this connective tissue disorder and fibromyalgia share similar pain mechanisms.
What does this study add?
In patients with JHS/EDS‐HT, the persistent nociceptive input due to joint abnormalities probably triggers central sensitization in the dorsal horn neurons and causes widespread pain.
To evaluate progression of symptoms and joint mobility in the joint hypermobility syndrome (JHS) in order to identify specific disease pictures by age at presentation.
Fifty JHS patients (44 females, ...6 males) were evaluated by Beighton score (BS) calculation, and presence/absence and age at onset of 20 key symptoms. Incidence and prevalence rates by age at onset and sex were calculated and compared by chi-square, Fisher's exact test and Mann-Whitney U-test. Relationship between BS and age at examination was evaluated by the Spearman rho correlation. The existence of an age cut-off separating patients with or without a positive BS was analysed by the receiver operating characteristic analysis. Influence of age on the single components of the BS was also investigated.
Except for isolated features, the overall clinical presentation was the same between sexes. In the whole sample, statistically significant differences by age at presentation were registered for fatigue, myalgias, muscle cramps, strains/sprains, dislocations, tendon ruptures, tendonitis, gastroesophageal reflux, chronic gastritis, constipation/diarrhoea and abdominal hernias. A clear inverse correlation between age at examination and BS was demonstrated with an age cut-off fixed at 33 years. Among the components of the BS, spine and elbow joints were not significantly influenced by age.
This study confirmed the existence of a protean clinical history of JHS which may be exemplified in different phases with distinguishable presentations. The knowledge of the peculiarities of each of them will help the practitioner in recognising and, hopefully, treating this condition.
Background
Cervical dystonia is a movement disorder characterized by involuntary and sustained contraction of the neck muscles that determines abnormal posture. The aim of this study was to ...investigate whether dystonic posture in patients with cervical dystonia affects walking and causes postural changes.
Methods
Patients with cervical dystonia and a group of age-matched healthy controls underwent an instrumental evaluation of the Timed Up and Go Test.
Findings
All the spatio-temporal parameters of the sub-phases of the Timed up and go test had a significantly higher duration in cervical dystonia patients compared to the control group while no differences in flection and extension angular amplitudes were observed. Indeed, we found that Cervical Dystonia patients had abnormalities in turning, as well as in standing-up and sitting-down from a chair during the Timed up and go test than healthy controls.
Interpretation
Impairment in postural control in cervical dystonia patients during walking and postural changes prompts to develop rehabilitation strategies to improve postural stability and reduce the risk of fall in these patients.
•Inertial sensors are useful to evaluate postural and walking functional test.•Cervical Dystonia patients have higher duration in Time Up and Go test.•Timed Up and Go alterations may be linked to deranged sensorimotor network of dystonia.
Patients affected by Charcot-Marie-Tooth (CMT) disease experience an impaired balance. Although the causes of the postural instability are not fully understood, somatosensory system seems to play a ...key role. Mechanical vibration seems to act on the somatosensory system and to improve its function. The aim of our study was to evaluate the effects of focal mechanical vibration (fMV) on the balance of CMT 1A patients. We enrolled 14 genetically confirmed CMT 1A patients (8 female and 6 male, mean age 492 years, range 32–74, mean duration of disease: 13 years, range 1–30). Patients underwent a 3-day fMV treatment on quadriceps and triceps surae and were evaluated before the treatment as well as 1 week and 1 month after the end of the treatment. The primary outcome measure was the Berg Balance Scale (BBS) and the secondary were the Dynamic Gait Index (DGI), the 6 Min Walking Test (6MWT), the muscular strength of lower limbs, the Quality of Life (QoL) questionnaire and the stabilometric variables. The statistical analysis showed a significant modification of the BBS due to the effect of treatment (
p
< 0.05). A significant modification was also found in the DGI (
p
< 0.05). Concerning the stabilometric variables we found significant changes only for the eyes closed condition; in particular, a significant decrease was found in Velocity
ML
(
p
< 0.05) and Sway path length (
p
< 0.05). The fMV treatment applied on lower limbs of CMT 1A patients determined an improvement of balance as detected by the BBS. The concurrent improvement of stabilometric variables in the eyes closed condition only suggests that fMV acts mostly on somatosensory afferences. Further studies are needed to confirm these data on a larger sample of CMT patients.
Abstract Gait impairment is one of the most frequent and life-altering consequences of Multiple sclerosis (MS), frequently associated with lower limb spasticity. Focal muscle vibration (fMV) is a ...technique that applies a vibratory stimulus to a specific muscle or its tendon, reducing spasticity. The aim of our study is to evaluate the efficacy of fMV in ameliorating gait impairment in MS patients with severe lower limb spasticity, measured by Gait Analysis (GA) and objective and patient-oriented scales scores. Fourteen patients affected by Secondary Progressive MS (SPMS) with a lower limb spasticity with a low or no response to antispastic drugs, received repetitive fMV (r-fMV) over the quadriceps and the lumbar paraspinal muscles. The effect of r-fMV on gait was measured by a GA evaluation and objective and patient-oriented scales scores, performed before r-fMV (T0), and 1 week (T1) and 1 month (T2) after the last session of r-fMV. After the r-fMV the most of spatio-temporal parameters calculated by GA were improved. Moreover, clinical evaluation related results showed an improvement of SM patients' quality of life. In conclusion, r-fMV improves gait function in MS patients affected by severe spasticity of lower limb, non-responsive to common oral antispastic drugs.
The BJWAT score significantly decreased after treatment with NMT application (p<0,05) evaluated with Friedman test.
NMT application seems to be a useful, non invasive and low cost treatment to ...associate with other treatments in the ma-nagement of diabetic foot ulcers.
Foot ulcers are major complications of diabetes mellitus and are estimated to affect 0.5-3% of the global population of people with diabetes. Treatment, prevention and management of foot ulcers is of paramount importance and utilisation of different preventa-tive strategies has been described in literature. The aim of this research study is to evaluate the possible integrative role of NeuroMuscolar Taping (NMT) in the treatment of diabetic foot ulcers.
This is an observational study involving patients with 3 to 5 degree of diabetic wound classification. The Bates-Jensen Wound Assessment Tool (BJWAT) was used before and after four weeks of NeuroMuscolar Taping applications.
Stroke is one of the leading causes for disability worldwide. Exercise therapy is a key element of stroke rehabilitation but no evidence are present in literature. Moreover recently focal muscle ...vibrationis described as a useful therapeutic approach in the post stroke recovery. In this study the efficacy of the vibration therapy in association to progressive modular re balancing rehabilitative approach has been evaluated and compared to the conventional therapy alone and associated to the muscle vibration.
A pilot randomized controlled trial, using a pragmatic triple-blind, parallel-group study design in chronic stroke patients upper limb function.
Functional outcomes resulted increased in the group treated with vibration therapy and in particular in the group associated to progressive modular rebalancing approach.
The combining neurophysiologically-based rehabilitative technique and vibration therapy may improve functional recovery in chronic stroke patients.
Highlights ► This study aims to investigate the involvement of the peripheral nervous system, with particular attention to entrapment syndromes, in JHS/EDS-HT patients by performing an extensive ...clinical, neurophysiological and ultrasonographic (US) examination. ► The study shows an inconsistency between symptoms and neurophysiological and ultrasound evidences of focal or diffuse nerve involvement. ► The high prevalence of ulnar nerve subluxation/luxation at elbow in Ehlers–Danlos syndromes/hypermobility type patients could be explained by the presence of Osborne ligament laxity.